想生BB 今日: 0 | 主題: 109602

積分: 9498

1083^#

發表於 11-5-26 12:11 |只看該作者

回覆 Whicheng 的帖子

Dear Whicheng,

Yes, it's hormonal replacement (estrofem is the clue, not progesterone). I think your luteal support medication is well-rounded even without the progesterone shots; so, don't feel stressed at all. It's always a "?" whether all the redundant medication is doing any good or not (as I mentioned before, many studies have already shown that just the vaginal progesterone alone is enough and as effective as progesterone shots). Don't forget that you are now up on the vaginal dosage, and you also had HCG as well. If there would be no bingo at the end, it would more be the embryo(s) rather than your endometrium failing you.

I also have no idea why your P4 level was ok last time but not this time. Perhaps it's a difference between a stimulated cycle and a hormonal replacement cycle. But again, a low serum P4 level would only matter if you were on P4 shots alone. In a woman who is on vaginal P4 only, her serum P4 would not be very different from a woman who is on her natural cycle (around the same time window) because vaginal P4 acts locally.

Let's think logically of this vaginal vs. intramuscular injection in relation to its serum level. For vaginal P4, you can imagine the long way for this vaginal P4 to be absorbed first by the endometrium, then any "unused" portion go into the bloodstream, which carries it to your entire body and some being absorbed by other tissues while in the circulation; so, how much of it left in the blood to be detectable by a P4 measurement?? On the other hand, P4 injection starts off in your muscle layer; the hormone needs to first go through the muscles into the bloodstream, which then circulates the entire body. Imagine the endometrium is like a small sponge, trying to soak up the P4 in your bloodstream. It's not hard to figure out that your serum P4 level needs to be quite high for the endometrium to soak up enough.

You may also want to know that hormones don't stay in your blood for very long. The body simply have ways to get rid of them and the hormones will naturally break down as well. I know your doctor probably did not re-check your serum P4 again, because the serum level does not really reflect much more useful info. In other words, the doctor is not too worried; and therefore, you should not either.

cutecutetown

點評

Whicheng Thanks cutecutetown, your explanation was far more detailed and comforting than the nurse. I think you spared your lunch time in answering my question, thanks so much for that. Really appreciated! 發表於 11-5-26 14:47

私人傳訊回覆引用

GentooMama

積分: 5486

1084^#

發表於 11-5-26 16:21 |只看該作者

Dear Cutecutetown ,

Thank you so much for your comfort. I am happy to tell you that I have reached the 2.5 milestone. Today I had the scan and heartbeat is seen. The size matched the gestation. Do you know after the heartbeat is detected, what will be the live birth rate? I am still scared because last time my twins heartbeat were seen too but two weeks after silently left. So I can only be cautiously optimistic!
Looking forward to reporting more milestone achievement.

點評

cutecutetown Is today about the 6th week of gestation? If you will reach 12th week and enter the 2nd trimester, things should be quite secured and the chance of live birth will be good. 發表於 11-5-26 18:21

cutecutetown Congratulations, this is a big stride forward!! Now if the embryo is "normal", it will continue on, simply stay cautiously optimistic la. 發表於 11-5-26 18:18

私人傳訊回覆引用

dolphindor

別墅

積分: 881

1085^#

發表於 11-5-26 16:57 |只看該作者

回覆 cutecutetown 的帖子

Hi Cutecutetown
I got the results of blood test already. The hCG level this morning was 22. My doc said it might be an indication of chemical pregnancy. And full Miss M has come today. She asked me to use HPT to test again next week to confirm there're no other complications..Though I expected this yesterday, I'm still pretty upset today and cried a few times.....

My hubby said it wasn't too bad and at least implantation might have occurred though it could not sustain. He said next time we can have a better chance..But I think the other way round. Maybe if no implantation occurred I'd feel a bit ...easier to cope with.

My doc said it may be down to egg quality(those dark pigments in the middle of my eggs). She said she wouldn't recommend DHEA because there're too many side effects. She also said a research is underway at QM's lab and once she learns the results she may suggest us what to do.

I know the bingo rate for 1st IVF is usually around 40 sth %. Do u have any data about cumulative IVF success rate in your lab? Somebody says it's around 80-905 for 3-4 rounds of IVF. I'd like to set a limit for that.

Also, as I read on BK it seems other jm's ivf cycles would involve more shots / blood tests than me during those 2 weeks. I only took vaginal inserts, 2 times a day. Maybe my doctor wanted to help me save time and money, but based our your experience about my situation, what should I request my doctor to do when I attempt a new IVF cycle?

Thank you

Dolphin

私人傳訊回覆引用

積分: 9498

1086^#

發表於 11-5-26 19:21 |只看該作者

回覆 dolphindor 的帖子

Dear Dolphin,

Sorry, I am feeling your sadness too. I think you have all the right to cry some more this and next week, but make sure you will be able to stand up again because things aren't that grim for you.

And I am impressed that your hubby has a very good science sense. I am sure he is also unhappy with this failed round, but he also sees and probably learns from this cycle. Is he a science person or a business man? While you are mourning over the implantation failure (well, women always tend to be more emotional, it's our right!), you hubby almost knows what I am going to say. The 22 hCG level is telling me that the embryo(s) has been growing and therefore being able to produce this hCG, although it is very weak (probably abnormal) and can't "hang on" in the womb. So, with some luck, you will hopefully have better embryos next time that are able to hang on.

I think it might be another jm mentioning about DHEA some time ago on my thread. For you who is still relatively young, producing reasonable number of eggs, you don't need to go for DHEA. Usually, at least it's what I feel after reading studies/documents on its use for ivf purposes, DHEA may help in women who are much older with very poor ovarian response (i.e. those of >40 yrs old and with almost no egg). So, wait for what your doctor can find out from QM's lab.

It does "WOW" me when reading the many more shots/blood tests some jm's have in their ivf or fet cycles. Do not think you need to do the same, because many of those shots and blood tests serve minimal to no purpose. I am 100% certain that your doctor is a fully professional reproductive specialist; so, you should feel safe about his/her management on you. If you want to learn more about the truth behind, you may want to read Posts #998, 1002, 1050, and 1083 in which I heavily explained the biology.

Cumulative success rate. 80-90% for 3-4 rounds of IVF?? Do you know if it is talking about bingo rate or live birth rate? I am afraid that's a figure for a selected group with good prognosis. I have recently looked at my own data in the past 4 yrs, although very crudely. I included all my patients, i.e. every woman who had come through. Their mean age was 36.0+/-3.7 yrs, with the majority ranged from 32 to 40 yrs old. The cumulative bingo rate per woman was ~52%, and cumulative live birth rate per woman (i.e. take home at least one baby) was ~42%. Some of them had a take-home baby right at the first time, some had it later in their FET, some had it in their 4th or 5th ivf. I didn't further look into how many attempts on average to get a baby because the whole lot is very diverse in age and subfertility reasons. But I had the general impression that for those who failed and kept trying, bingo seemed to be much harder when there is never a bingo after 4 IVFs.

Last word, listen to your hubby. He has very good instinct about your veggie meals and also the hCG level. Stay well and prepare yourself when you are ready.
cutecutetown

私人傳訊回覆引用

GentooMama

積分: 5486

1087^#

發表於 11-5-26 19:34 |只看該作者

Dear Cutecutetown ,

Yes today is 6 weeks 2 days. So it is still a long way to reach the next milestone. 6 weeks looks more than 6 years for me. I will hang in there. Hopefully since this time there is only one embryo, the outcome can be different from last time's twins la! Really hope to see your congratulations again!

私人傳訊回覆引用

積分: 2603

1088^#

發表於 11-5-26 20:37 |只看該作者

Dear Cutecutetown,
I'm back from egg retreival! Thanks God that the procedure was much smoother and successful than expected.

My Dr finally managed to retreive all the eggs from the vagina and no need to drill through my abdomen. I guess the anesthetist came for standby mainly, but he's such a pleasant doctor that I felt safe in his hand indeed (though the charge is not so pleasant

)
Guess what, I was told that a total of 17 eggs are retreived. It's a lot more than I expected. I wonder if what my Dr said previously was to lower my expectation only, or is he really so good technically?! Anyway...
Also, I checked up with the nurse in PYNEH and she told me that in the last 3 IUI i did there, my endometrium was around 10mm thick. And no polyps found in previous hysteroscopy indeed. So I truly hope that this time is just a particular incident and my linings will become normal after some rest.
So, do you know if Gonal-F might be a cause for such thickened endometrium? Also, what shall I look for and pay attention to in the following stages? I'm q. confused about all the gradings for eggs and embryos....

私人傳訊回覆引用

florencelai004

複式洋房

積分: 146

1089^#

發表於 11-5-26 20:46 |只看該作者

請問ivf and iui是什麼

謝謝

點評

cutecutetown IVF = In Vitro Fertilization
IUI = Intra-Uterine Insemination 發表於 11-5-26 22:15

私人傳訊回覆引用

積分: 9498

1090^#

發表於 11-5-26 22:50 |只看該作者

Dear糟糟豬,

That's such a good news. Your last hormone mentioned ~2 posts ago (14xxx) somewhat told me you would have >14 eggs if things went well; but just like your doctor, I didn't want to make your hope too high in case the eggs were hard to access.

Now I am a little worried if you may develop OHSS (only a very small possibility, your doctor will know better). Don't get worried by what I just said. Does your doctor plan a fresh ET in a few days for you, or wait till another cycle after your polyp is taken care of? I think you have done great so far, and simply just follow the natural course.

Gonal-F should not affect endometrial thickness. If you don't have thickened lining in your previous IUIs, perhaps this cycle is a coincidence, or something else underlying which wasn't identified before. After this round, see what your doctor's advice will be in terms of quick investigation of your uterus.

Gradings ....... although it's a regular tool to help decide what should be good or bad, remember it is not an absolute method. Usually your doctor will guide you through with the developmental stage and grade, telling you whether an embryo is good, average, or bad. The numbers (cells) or ABC's (grades) are something more solid to give us reference points, but don't get "obsessed" with its value. For example, let's say an embryo is best when it contains 8 cells on day 3 of development; then, is a 6-cell embryo on day 3 not good? It may be just a tiny fraction slower, but it may have similar potential as the 8-cell. But of course, when we have a bunch of embryos to choose from, we often go for an 8-cell first instead of a 6-cell.

And now, you know you can also come here when you feel confused

cutecutetown

私人傳訊回覆引用

積分: 2603

1091^#

發表於 11-5-26 23:40 |只看該作者

回覆 cutecutetown 的帖子

Hi cutecutetown,

Thanks for your reply. I don't feel too much discomfort so far. Not too much bloating, no nausea or vomitting. But as said before, I started to have 水腫腳 & broader hip since 4th day of injection, but it seem to be a little bit better in recent few days in fact. I thought I gained around 2-3 pounds in this course of IVF. So I guess very low chance of OHSS gwa....

I won't do ET this cycle anyway. Have no chance to talk to the doctor yet after ER today. But the latest consent is to clarify why the endometrium is so thick. My hubby and I prefer not to do hysteroscopy again. So we may want to rest for a cycle or two to see if the endometrium will become "normal". I heard from the nurse today that the Dr also suggested a possible examination by filling into the womb some saline? I'm not sure what this is about. And certainly need to ask them later.

Btw, when should I expect Miss M to visit me again? Is it just as in natural cycle, around 14 days?

Thanks...

點評

cutecutetown Roughly around that time frame, some may take a little longer. 發表於 11-5-27 12:14

mother2be my experience is that Miss M will come around 15-16 after egg retrieval. 發表於 11-5-27 09:22

私人傳訊回覆引用

mother2be

積分: 2731

1092^#

發表於 11-5-27 09:40 |只看該作者

回覆 cutecutetown 的帖子

Dear Cutecutetown,

I am saddened and have a sense of heaviness when I read your findings that "for those who failed and kept trying, bingo seemed to be much harder when there is never a bingo after 4 IVFs". I believe you are talking about 4 times embroyo transfer (including FET), not 4 full fresh cycles. But it does not make a big difference.

I have tried two times fresh embroyo transfer (and have one FET cancelled as the embroyos after thawing were not good). When my second time didn't hit, I was so depressed and felt hopeless, because I am using up one more chance. If the coming IVF has no bingo at all, it will seems that my last resort - IVF, does not work. That will mean I will be infertile forever.

Am I overly scaring myself? Initially I thought I am, but after reading your findings - I do think recurrent try of IVFs does not add much more value. Now I only have two more chances. If there is no more bingos, what else can I do?

Regards,
Mother2be

私人傳訊回覆引用

積分: 9498

1093^#

發表於 11-5-27 12:28 |只看該作者

本帖最後由 cutecutetown 於 11-5-27 12:36 編輯

回覆 mother2be 的帖子

Dear mother2be,

I do mean 4 full ivf cycles or cycles with egg retrieval, which possibly leads to more than 4 ET events. When applied to your case, you still haven't quite "used up" your second cycle yet.

"Bingo ... seemed harder ... after 4 ivf's" is only my general impression, and I get patients who bingo on their 5th, 6th, or even 12th IVF. I can't really do good statistics with this group of patients because there are not too many of them around to make an objective conclusion; so I rather not give a % here.

Afterall, you are still overly scaring yourself. If you won't bingo before starting your 3rd cycle, perhaps we can look at what can be done with your daily habits, diet, lifestyle, environmental factors, etc. I believe you are emotionally and financially drained (if you haven't exaggerated previously) and will need some time to stock up on your ammunition anyway.

Note that your doctor hasn't given up and I don't see a reason to be so despaired, you shouldn't either.
cutecutetown

私人傳訊回覆引用

mother2be

積分: 2731

1094^#

發表於 11-5-27 14:02 |只看該作者

回覆 cutecutetown 的帖子

I have slightly exaggerated my "physically and emotionally drained" state. To put it strictly, I am emotionally drained, but physical wise, I am fine as I have good health - the egg retrieval and injection process was bearable to me. I had no major side-effects so far.

As to financially, if I really want to, I can afford upto 7 full cycles every other month while not eating into my savings yet. But can I emotionally go that far? My purpose of working now is to earn money for medication.

Afterall, I am not a billionaire with unlimited resources. For every chance, I am becoming more careful to use up each resources. as each down, will once again drain me physically, emotionally, and financial. i can rebound again and again. i don't know how many times I can rebound.

The only difference this cylce is my natural luteal support is stronger than last fresh cycle, given the same medication is used. Last time, I already felt Miss M is going to come on 4 days after transfer. This time, the support lasts much longer (at least 12 days after transfer) and I am using day 3 emboroys. I am thinking if this is already a sign of improvement and is a sign that implantation had taken place.

If my assumption is correct, my hope reignited because there were some improvement/progress from 1st time.

私人傳訊回覆引用

積分: 2603

1095^#

發表於 11-5-28 10:39 |只看該作者

本帖最後由糟糟豬於 11-5-28 17:36 編輯

Dear Cutecutetown,

I can't wait to share with you this good news. Just now my clinic called me and said out of the 17 eggs retreived, 13 got fertilized, and they are all of good quality and can be frozen. I checked out with the nurse and she said two Grade 2+, one Grade 1- and all others are Grade 1 embryos, most are 4-cell by this morning, with one 2-cell and one 6-celll...
But as I read the report, I found that there wrote "Total no. of oocytes injected" instead of "total no. of oocytes IVF"... so i guess that mean they did ICSI with us? Under what circumstances will embryologists do such decision?

Also, my doctor said we may try FET as usual if the next checkup shows that the endometrium is back to normal thickness. Will consider doing hysteroscopy again only if that fails. So hopefully waiting for 1.5 month more and I can go on with FET.

Jojoju

點評

cutecutetown Scientifically, the lab bases its IVF vs ICSI decision on sperm quality unless the patient had history of failed/poor fertilization from IVF. However, many priate clinics just do ICSI for all. 發表於 11-5-29 00:11

cutecutetown This is indeed good news and I am very happy for you. I hope your endometrium will resume its normalcy so that FET can happen soon. 發表於 11-5-29 00:08

私人傳訊回覆引用

PWYO7657

複式洋房

積分: 348

1096^#

發表於 11-5-28 17:24 |只看該作者

Dear Cutecutetown

i heard 'molar pregnancy' and noted that this may happen in ivf. i am thinking if the embryo has been cultivated for at least 3 or 5 days in the lab before transfer, why there will still molar pregnancy in ivf?

點評

cutecutetown Clinically, I am probably not the expert to ask. 發表於 11-5-29 00:22

cutecutetown It also happens in natural conception and I don't see its prevalence increases as a result of ivf. 發表於 11-5-29 00:21

私人傳訊回覆引用

littleantant

積分: 6513

1097^#

發表於 11-5-28 22:11 |只看該作者

DEAR Cutecutetown,

i m happy that i will do fet next wed. i heard some jms said that dr will see the endometrium b4 fet,but my dr didn't request me back to hospital and check the endometrium, only told me that i hv to go to hospital(fet) next wed.endometrium checking b4 fet is not a must,isn't it?

littleantant

點評

cutecutetown You are doing natural-cycle FET, right? Your doc may just do a quick scan right before the fet procedure. 發表於 11-5-29 00:32

cutecutetown I believe your endometrium was checked (for thickness and any abnormal morphology) some time during your ivf cycle. That was back in March?, which wasn't too long ago. 發表於 11-5-29 00:31

私人傳訊回覆引用

littleantant

積分: 6513

1098^#

發表於 11-5-29 13:50 |只看該作者

回覆 littleantant 的帖子

明白了，謝謝你呀， CUTECUTETOWN，

希望下次能告訴你好消息啦

私人傳訊回覆引用

積分: 2603

1099^#

發表於 11-5-30 00:25 |只看該作者

sorry cutecutetown, will u mind telling me is there any cut-off or standard for sperm quality for choosing ICSI? i understand there may be different standards in different lab, but is there any general rule of thumb or guideline?
I was thinking if it's becoz the morphology of my hubby's sperm is below standard? but i was told (in the past) that as long as the sperm count and motility are ok, ivf will be sufficient... or the pic is far more complicated than i suppose?

點評

cutecutetown Different labs have different "cut-off" for ICSI decision (although many private doctors dictate this decision). 發表於 11-5-30 09:42

cutecutetown I suspect your ivf cycle is done with a private clinic/doctor. Most, if not all, private setting will do ICSI regardless of sperm quality. 發表於 11-5-30 09:35

私人傳訊回覆引用